The most severe disease among the neurodegenerative disorders that affect the nerve cells controlling muscle activity.

The disease is also known as Lou Gehrig’s disease, named after the American baseball player who was diagnosed with it in the 1930s.

It is a rare and incurable disease that affects the motor nerve cells through which the brain controls the operation of most voluntary muscles in the body.

In ALS patients, these nerve cells degenerate, making them unable to activate the muscles. Gradually, the muscles themselves weaken due to inactivity until they become completely paralysed and atrophied.

During the course of the disease, the muscles responsible for the movement of the limbs, swallowing, speech, and breathing are gradually affected (in almost a fixed order).

About 10% of ALS cases are inherited, and in some familial cases of the disease, the genes responsible for the disease have been identified, which may help in the future in finding treatments for these patients.
In other cases, there is no way to predict the onset of the disease in a specific individual, and it is not known what triggers it to erupt.

Among ALS patients, most survive between 3 to 5 years from the time of diagnosis.

20% extend to around 10 years, and an additional 10% live with the disease for a longer time.

Symptoms:
At the onset of the disease, there is usually a symptom of foot drop.
The foot droops forward, making it very difficult to lift it upwards.

Patients have difficulty walking and tend to complain of instability and stumbling.
General weakness of the limbs develops gradually, along with difficulty exerting force.

Over time, the weakness progresses to complete paralysis, and since patients do not use the weak muscles, muscle atrophy gradually appears.

Additional symptoms include: swallowing, speech, and breathing difficulties that occur when muscle paralysis spreads to the facial and throat areas.

In advanced stages, patients require devices to assist with breathing.
Additionally, the disease manifests with spasms that can occur in the hands, legs, tongue, and elsewhere.

The cause of the disease is unclear, and researchers currently believe that it may occur due to genetic factors but also because of chemical imbalance, immune dysfunction, or protein accumulation disorder.

In practice, it involves damage to the motor nuclei located in the spinal cord’s lateral columns.
The spinal cord consists of several columns, each filling a different role in transmitting nervous information.

The lateral columns are associated with the motor system, and damage to them ultimately leads to the disease.
Since the damage is limited to the motor part of the spinal cord, the disease does not manifest (almost until the end) with additional symptoms of spinal cord injuries such as sensory disturbances or loss of control over sphincters.

Researchers estimate that ALS may also be non-inherited due to damage to protective enzymes, damage that can result from exposure to various toxins such as heavy metals, pesticides, viral infections, and even physical trauma.
However, it should be emphasised that this is currently only a theory.

There is another theory that ALS is a result of a phenomenon called “excitotoxicity.” According to this theory, motor nerve cells undergo excessive stimulation of a neurotransmitter called glutamate.
This excessive stimulation causes the death of these nerve cells.

Diagnosis of the disease:
Diagnosis is not simple because its symptoms are also characteristic of a wide range of more common diseases.

Diagnostic methods include:

• EMG examination, which examines electrical changes in muscles at rest and in
  motion.
• Nerve conduction testing, which examines the strength of the electrical signal in
  nerves and its walking speed.
• MRI testing, which checks brain integrity to rule out a brain cause such as a tumour.
• Performing a muscle biopsy to distinguish between muscle-origin diseases and
  nerve-origin diseases.

Medical treatments:
As of today, there is no way to repair the severe nerve damage that occurs in patients, and most therapeutic efforts are aimed at reducing damage, slowing down deterioration, and providing patients with a few more months or years of reasonable functioning.

Today’s treatments are divided into 2 categories: pharmaceutical and functional assistance.

The only medication today is called Riluzole, which slows the progression of the disease but does not stop it.

The medication reduces the levels of glutamate (an amino acid that serves as a neurotransmitter in the brain), which is high in ALS patients.

Since the main disorder in patients is functional, physical therapy and occupational therapy can provide them with tools to cope with their difficulties: muscle strengthening, preserving some level of mobility, coping with limitations while maintaining a certain level of independence.

Patients with speech and swallowing disorders sometimes seek the assistance of a speech therapist.

Reflexology treatment:
Reflexology treatment for ALS patients aims to strengthen the body’s muscles.
Additionally, based on the patient’s preferences, it may involve stimulating blood circulation or inducing relaxation.

Similar to other incurable life-threatening diseases, the primary objective of reflexology treatment is to fulfil the patient’s desires.

From my experience, most patients seek relaxation.
The calming treatment, accompanied by gentle background music, allows them to close their eyes and rest.
Hopefully, even if only for a brief period, it helps them momentarily forget about their unbearable reality.